Asthma is the most common chronic condition among children, but in 50 per cent of cases, symptoms decrease drastically as they reach the teenage years. Symptoms, however, may also show up for the first time in adulthood. And the older we are, the more likely we are to suffer from a more severe kind of asthma.

I hate to think that people will throw flowers over my coffin

Cynthia*, 38, never had respiratory problems before she got a severe bout of flu six years ago and could not stop coughing for two months. What she thought were flu symptoms eventually turned out to be asthma.

“Spring is the worst time for me,” says Cynthia. “And certain smells, such as detergents and perfumes, and alcohol are lately causing attacks.” The fact that she cannot take a sip of alcohol when she is out with family and friends really annoys her, but other than that, she says the condition does not affect her everyday life.

Recently, she was sick with bronchitis and the smell of flowers and car air freshener made her cough. She threw up and had to use her inhaler to calm down. Cynthia’s worst fear is, in fact, running out of Ventolin and being unable to buy it after certain times of the day.

David*, 43, was diagnosed with asthma at 17. As a child he started suffering from hay fever, but the symptoms aggravated when he joined a textiles firm.

“I had to take steroids and other medications, but my GP eventually referred me to an asthma specialist.”

David’s condition is under control, but he always carries three different types of inhalers and a nasal spray.

He does not use perfume, uses cotton bed sheets and does not have any pets. He also tries to avoid the countryside because of the pollen.

David recalls one nasty episode while he was driving: “I had a major bout of coughing and sneezing and hit the roadside pavement and damaged the car.”

Since his asthma is under control, however, David says he does not have any major fears.

“Yet I hate to think that people will throw flowers over my coffin,” he jokes.

*Names have been changed.

Common triggers

Cynthia and David’s cases are not isolated, as various circumstances may trigger asthma in adult life.

“Individuals suffering from allergic conditions, such as rhinitis and eczema, or who are exposed to certain allergens/irritants, or following an upper respiratory tract infection, may develop asthma symptoms,” explains Stephen Montefort, lead consultant respiratory physician at Mater Dei Hospital.

Others develop asthma because of occupational exposure to certain materials, such as flour (referred to as bakers’ asthma). Other at-risk individuals include sprayers, carpenters and farmers.

One of the hypotheses for the increase in the prevalence of asthma worldwide is thought to be related to “our developing lifestyle”.

Prof. Montefort refers to the so-called ‘hygiene hypothesis’ that stipulates that in the past, many infants, who used to get a number of infections for which there are vaccines today, were less likely to suffer from allergies later on in life.

“This is thought to be due to the fact that their immune system was more targeted at fighting infections than allergies. But in no way are we saying that infants should not be vaccinated as the benefits outweigh the risks.”

Asthmatics tend also to be potentially sensitive to various common drugs, and in about 20 per cent of cases, these include aspirin and non-steroidal anti-inflammatory drugs (NSAIDS), which are commonly used for aches and pains.

Other drugs, like blood pressure tablets called beta blockers (also found in some glaucoma eye drops) can lead to potential worsening of the asthmatic symptoms.

Prof. Montefort says that those who suffer from asthma as children and seemingly grow out of it, must be very careful, because if the condition was allergic in nature, “they will always remain susceptible”.

“Symptoms can recur either in the chest or elsewhere. So they should avoid triggers such as smoking or choosing the wrong occupation. Chest infection and pregnancy have also been cited as being the cause for such recurrence.”

Industrialised areas are thought to be more likely to be inducers of such symptoms because of the production of pollutants.

The 2002 ISAAC (International Study of Asthma and Allergies in Childhood) study, in fact, found an increase in the prevalence of asthma in five- to eight-year-old Maltese children in certain, more industrialised areas of the country, namely the Central East, East and Grand Harbour areas.

However, some controversial studies question the link between pollution and asthma. One such research, carried out after the fall of the Berlin Wall, found that industrialised areas in East Germany had lower levels of asthma than less polluted zones in West Germany.

All this goes to show that the environment may be an important trigger, but genetics are also very important. In fact, a local study had found that most asthma sufferers also had relatives with allergic conditions.

Other interesting findings from past studies were that passive smokers and smokers had a higher prevalence of allergic conditions; children were more susceptible to asthma if their mother was a smoker and especially if she smoked during the first year of their lives; and individuals who were given antibiotics and paracetamol early on in life were more likely to be wheezers in later life.